Multidrug-resistant organisms (MDROs) are bacteria that have developed the ability to withstand treatment by several different types of antibiotics, making resulting infections difficult to cure. These resistant microbes can be found in the environment or colonizing a person (carrying the organism without showing symptoms). The primary concern for MDRO transmission is within healthcare facilities, such as hospitals and long-term care centers, where patients are vulnerable and have greater exposure to antibiotics. Strict protocols are implemented in these settings to prevent the spread of MDROs through contact with contaminated surfaces, equipment, and people. These layered precautions are designed to contain the microbes, protecting staff and other patients from colonization and subsequent infection.
Foundational Infection Control
The baseline for preventing the spread of any infectious agent, including MDROs, is Standard Precautions, which apply universally to every patient encounter. The most effective measure within this framework is rigorous hand hygiene, performed by healthcare workers before and after every patient contact. Hands must also be cleaned after touching blood, body fluids, non-intact skin, or contaminated items, even if gloves were worn.
If hands are visibly soiled, washing with soap and water is required for 40 to 60 seconds, thoroughly covering all surfaces. When hands are not visibly soiled, an alcohol-based hand rub is used, covering all surfaces and rubbed until dry (20 to 30 seconds). Standard Precautions also include the use of personal protective equipment (PPE), like gloves, whenever contact with potentially infectious material is anticipated.
Implementing Patient Isolation
When a patient is known or suspected to be colonized or infected with an MDRO, the healthcare facility institutes enhanced measures called Contact Precautions. The preferred arrangement is placing the patient in a single, private room to minimize transmission risk. If a private room is unavailable, the patient may be cohorted with another patient who has the exact same MDRO, provided their health status permits.
Contact Precautions mandate the use of full-body PPE before entering the room. Any person entering, including staff and visitors, must put on a clean isolation gown and gloves. This equipment serves as a physical barrier to prevent the MDRO from contaminating the individual’s skin or clothing.
The sequence for removing PPE is strictly controlled to prevent self-contamination. The gown and gloves must be removed and disposed of inside the patient’s room before exiting. Hand hygiene must be performed immediately following the removal of this contaminated gear, which is the final step before leaving the isolation area.
Patient mobility is restricted to limit the spread of MDROs within the facility. Patients must remain in their room unless movement is necessary for required medical procedures or tests. If the patient must leave the room, they are required to wear a clean gown and perform hand hygiene immediately before transport to prevent contamination of common areas.
Managing the Physical Environment
The physical environment of an MDRO patient’s room can become a reservoir, as these microbes can survive on surfaces for extended periods. Environmental cleaning protocols are intensified to address this risk. High-touch surfaces within the patient zone receive frequent and thorough disinfection, including:
- Bed rails
- Bedside tables
- Doorknobs
- Bathroom fixtures
Cleaning staff use a systematic approach, often moving from cleaner to dirtier areas and employing specific approved disinfectants. These disinfectants are selected based on their proven ability to kill the target MDRO and must be used according to manufacturer’s instructions for the correct contact time. To prevent cross-contamination, cleaning materials used in an MDRO patient’s room are discarded after use and are not reused in other patient areas.
When a patient is discharged, the room undergoes terminal cleaning. This involves deep cleaning and disinfection of all surfaces, sometimes supplemented by advanced methods like Ultraviolet-C (UV-C) light or hydrogen peroxide vapor (HPV) treatment. These supplemental methods reduce the microbial load on surfaces that may have been missed during manual cleaning.
Non-critical items like stethoscopes, blood pressure cuffs, and thermometers must be dedicated for single-patient use. If shared reusable equipment is brought into the room, it must be meticulously cleaned and disinfected before being used on any other patient. Contaminated linens and medical waste are handled separately, placed in designated bags before removal from the isolation room to prevent environmental spread during transport.
Patient and Visitor Compliance
Effective containment of MDROs relies heavily on the cooperation of the patient and their visitors, who receive specific education on the precaution process. Patients are taught the importance of consistent hand hygiene, particularly before eating and after using the toilet, and are encouraged to remain within their designated room. This personal action limits the transfer of the organism to the immediate environment.
Visitors must adhere to the same infection control guidelines as staff to protect themselves and prevent carrying the organism out of the room. They are instructed to clean their hands upon entering and leaving the room. Visitors may be asked to wear a gown and gloves, especially if they anticipate touching the patient or the immediate environment. Visitors who are ill or have had recent exposure to an infectious disease are restricted from visiting.
Items brought into the isolation room are often restricted, or visitors may be advised to leave non-essential belongings outside to avoid contamination. Upon discharge, education continues with clear instructions for home precautions, focusing on consistent hand hygiene for the patient and any caregiver. These continued home precautions are aimed at preventing transmission to household contacts who may be at risk.